Owen's Rough First Week and his Surgery

Just a note, these posts are pretty much stream of consciousness, so they often jump all over the place and may sometimes be repetitive.  My apologies for that, but with everything going on right now, I don't really have time to edit.

At the end of the first week with the triplets in the NICU (Neo-Natal Intensive Care Unit) baby Owen had a bit of a setback. Poor little guy has been fighting since he got out of the womb.

Nikki was recovering at home on Thursday June 4th, and I had elected to also work from home that day to watch her in case she was having any issues.  She had just been sent home from the hospital two days prior.  The night before (Wednesday), I remember commenting to Nikki about how good Owen looked, and how he had put on a fair bit of weight recently.  In fact he had caught up and surpassed Noah and was now the heaviest baby at 2lbs 1oz.  As a side note, babies, particularly preemies tend to lose 10% or more of their weight in the first week or two.  This is because the fluids they had retained in the womb typically get passed during that time.  Noah had lost five ounces to go down to 2lbs and Bella had lost a couple of ounces too.  The only one to put on weight so far was Owen.

Anyways, on my lunch I took my bike up to the local Wilson Farms to get some Gatorade for Nikki, which helps keep her hydrated during the frequent breast pumpings for milk.  I decided to do a quick couple of miles up and down McKinley Parkway because it was the first time I had the bike out this year and it was a beautiful, warm spring day.  All told, I was gone a half hour at most.  When I got back, Nikki was on the phone with the nurse, and I recall her asking the nurse something about what happens if he loses his bowel. 

Nikki handed me the phone as she was getting upset and the doctors, for whatever reason, prefer to deal with the father when something is going wrong.  The RN told me on the phone that Owen had NEC (Necrotizing Enterocolitis) and that he would be having surgery shortly.  She said we needed to come down immediately.  NEC is often lethal, particularly for babies as premature as ours.  Basically, it means that your intestines are dying and no one really knows what causes it. While Nikki was dressing, I Googled NEC and, of course, the first few hits were about stories of tragic loss, so I was feeling crushed on the inside.  I don't hide things from my wife, so I discussed some of the potential issues surrounding NEC, and then we left for the hospital.

Ironically, on the day the babies were born, the research staff asked if we would enroll our babies in a study on NEC.  All they wanted from us was permission to have their used diapers and stool samples.  We agreed, as we felt there was no harm to our babies…unlike other studies that the research staff had asked us to participate in (fodder for a future post).

When we arrived at the hospital about a half hour later, the nurse had us speak to the attending doctor, who was a bit unsure about his earlier prognosis.  He told me that they had given Owen an X-ray and that it was definitely suspicious.  Babies should not be vomiting bile, first of all, and they then informed us that Owen had vomited nearly 13cc's at around 12:30 that day.  When the doctor showed me the X-Ray he pointed to some spots that indicated some irritation in the areas surrounding his intestines.  There were a few areas that were possibly pockets of air outside the intestines, but the doctors weren't sure.  The pockets of air typically mean that the intestines have been perforated. 

Cautiously, they began treating Owen with antibiotics.  They noted that opening up a premature baby to surgery has its own inherent risks, not the least of which is opening up the possibility of further infection to internal organs.  They don't want to operate on a baby unless they are absolutely certain it is a necessity. 

So, not being sure, they decided that another X-Ray was in order and so they placed Owen on his side for about a half hour so that any pockets of air would sort of float to the top (his side facing upward) just like bubbles roll to the top of a glass of soda. They also began to suction out Owen's stomach of additional bile that was still collecting. 

I apologize for the somewhat graphic detail here, but as this is a blog, widely available on the web, it is my hope that somebody else who may find themselves in our position some day, would benefit from reading this.

I kind of lost track of time at this point.  The doctors kept taking me over to the X-Ray and ultrasounds to explain things.  I am a reasonably intelligent person and I catch on to new concepts fast, but I was a horrible Biology student in high school.  I was catching on to most of what they were talking about, but failing miserably in trying to disseminate it to my wife.

After a subsequent X-Ray came thru, the doctors saw that the suspicious area near his ribs had expanded and there were now fairly certain that it was air.  The presence of which, indicated that his small intestine was probably perforated.  The doctors told us that they didn't think he had NEC, but wouldn't know for sure until they opened Owen up.  They thought he might have what is called Sudden Intestinal Perforation (SIP), which is more common in preemies who are still on a feeding tube.  Basically, his intestines are too immature at this stage to handle passing waste.  While Nikki and I were still very worried, we felt a lot better that it didn't seem like Owen had NEC.

The surgical team was then called together to come upstairs to talk to Nikki and I about the next steps.  The lead surgeon, Dr. Caty, is someone with a great deal of experience in operating on premature babies and he immediately had a calming effect on us as he told us about the surgery and how this was rather routine for him, and not uncommon in preemies Owen's age.  He told us that they would make a two inch incision in his belly and search for the perforation.  They would the remove the performated portion of the intestine and leave the good end of the small intestine sticking out of his wound for about six weeks, while they watch it.  They would also suction out the waste that had spilled into the cavities around the intestines.  They hope to see some green fluid coming out of the intestine after a week to ten days and then they watch Owen to make sure he is putting on some weight.  After six weeks, they will reattach the small intestine to the large intestine.  It is a procedure that, if successful, the baby should have no further issues in that respect.  A second perforation is extremely rare for a baby.  The surgeon told us that babies typically do just fine as far as whether they can survive the surgery.  The biggest concern is how much of the intestine if perforated.  If it is a large enough section, there is not much that the surgeons can do for the baby.  You need your intestines to survive.

We were given a few minutes to be with Owen before the surgery and we gave him our love.  I used a breathing technique and visualization exercise to send Owen love and strength.  Basically imagining myself transferring energy to every cell in his body, in the form of love.  Yeah, I know I'm a flake.  Desperate times call for desperate measures.

It actually took longer to assemble the surgical team than to actually perform the operation.  Forty-five minutes after they put him under, the doctor came to talk to us in our private waiting room and told us that the surgery could not have gone any better and that Owen did wonderfully.  I cannot thank the staff at Children's hospital of Buffalo enough.  We are so very lucky that Owen was there, being watched by the nurses in the NICU.  They responded quickly and made all the right moves.  I hate to think what would have happened if Owen had gone to sleep that night without being treated.  I don't think he would have woken up the next morning.

So Owen is doing well.  At regular intervals, the nurses will put a vasoline-soaked gauze on his wound, to keep the tip of the small intestine moist, and then they cover it with more gauze and a diaper.  So, when you see Owen, you would not know that he just had major intestinal surgery.

While he looks like he may be in pain, his blood pressure, clotting, blood gases etc, are doing very well.  He even opened up his eyes for us for the first time today, just two days after his surgery.  I cannot tell you how happy that made me today when the little guy stared up and his Mommy and Daddy.  My parents and my Aunt Donna were also there to see this little miracle, wide-eyed (for him) as if to say to his parents, "tell me it gets better."  It does, little buddy, it does.  I promise.

- Papa Charley